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General NPI Number Information
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NPI Number | 1982762761
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Entity Type | Individual
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Provider Name | STEPHEN JOHN GROTH MD
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Gender | Male
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 10/06/2012
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Provider Practice Location Address
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Address Line | 554 DIAMOND ST
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-3404
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Country | US
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Telephone | 949-306-7383
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Fax | 949-497-1141
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Provider Business Mailing Address
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Address Line | 554 DIAMOND ST
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-3404
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Country | US
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Telephone | 949-306-7383
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Fax | 949-497-1141
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | G36991
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | G36991
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License Number State | CA
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